Home medicines seem bound to play an increasingly important part in everyday medical care. Medical services everywhere are under tremendous pressure with health care professionals often unable to provide more than a rudimentary service for the majority of patients and generally unwilling to provide advice for minor, self-limiting problems. In addition, the faith of patients in the available medical services has taken a heavy battering in recent years. It is sometimes said, for example, that if a patient in hospital has two diseases the chances are that the second disease was caused by the treatment for the first. Inevitably this sort of knowledge has damaged the doctor-patient relationship with the result that many people are actively interested in acquiring a rudimentary knowledge of self-help techniques.
There is, however, a warning which needs to be sounded loud and very clear. Just as doctors are likely to make mistakes when prescribing drugs, partly because of the variety and complexity of modern medicines, so patients are likely to make mistakes in self-diagnosis. And then home medicines can be just as dangerous as prescription medicines. In this section I have outlined some of the ways in which home medicines can prove to be a problem in the hope that once the risk areas are identified the dangers can be minimized.
One of the greatest hazards of home medicines is that they may lull the patient into a false sense of security by providing him with symptomatic relief or even, on occasion, by making him fee/ that they have provided him with symptomatic relief.
For example, a car industry executive noticed that about half an hour after his breakfast and half an hour before his evening meal he was getting pains across the top part of his abdomen. He decided that the pains were caused by indigestion and so he bought a bottle of antacid mixture from a local chemist’s shop. It didn’t help much buthe thoughthe would persevere and so he tried a different brand.
Once or twice the pain was so bad that it actually seemed to make him breathless but the executive noticed that if he stopped and took a good swallow from his bottle of white indigestion medicine and then waited for a couple of minutes the pain and the breathlessness would both disappear.
He went on like this for six months. And then had a heart attack.
Whathe had been suffering from had not been indigestion but angina – an early warning sign of heart disease. The pains had developed after breakfast and before his evening meal because he walked to his office every morning and walked home again after work. The pains were brought on by exercise not hunger or food. And it was not the indigestion medicine but the rest which brought him relief.
That man’s mistake could have been fatal. If he had visited a doctor after the pains had persisted instead of simply buying bottle after bottle of medicine an earlier diagnosis could have been made and that heart attack perhaps avoided.
Similarly, a patient who takes repeated doses of an antacid for whathe thinks is indigestion and who actually docs obtain genuine relief may well be masking the early signs of peptic ulceration. The antacid will not cure the condition and may, by delaying the time at which professional help is sought, mean that the future prognosis is not as good as it might have been.
The moral is that home medicines should be used as short-term palliatives and never as long-term solutions.
Many diabetic patients understand their disease extremely well, knowing a great deal about the potential complications and the hazards of disobeying instructions relating to the use of tablets, insulin or food. The shop assistant I’m about to describe was no exception.
She always watched her diet carefully and regulated her intake of sugar wisely. She took tablets every morning to help stimulate the production of insulin within her body. I was extremely surprised when she went out of control and had to be taken into hospital unconscious.
Her problem had simply been that in an attempt to cure a persistent cough she had swallowed bottlefuls of a well-known brand of cough medicine. The cough medicine contained a large quantity of sugar and had been quite enough to throw her diabetes out of control.
The moral here is that anyone who suffers from a chronic, long-term disease or who takes medicines prescribed by a doctor should not take any home medicine without their doctor’s permission. Combinations between some prescribed and non-prescribed medicines can be fatal.
THE HAZARDS OF THE MEDICATION ITSELF
Home medicines can easily cause major side effects when they are used improperly. Used at the proper dose for the proper length of time they are relatively safe. Used at the wrong dose for too long they can be just as fatal as much more powerful drugs.
One patient I remember very well had been taking aspirin tablets every day for many years. She didn’t know that she was taking aspirin tablets because she was taking a well-known branded product that is frequently advertised on the television as an effective painkiller. She took these pills daily because she believed that they helped to prevent monthly period pain. The absence of period pain seemed to simply confirm her belief in the efficacy of her home treatment. Just as the man who claims that elephant powder keeps elephants away can prove it by pointing to the absence of elephants in the neighbourhood.
I saw her when she first started to complain of stomach pains. She had given herself gastritis which cleared up quickly and completely once she had abandoned her silly and damaging habit.
A comprehensive survey of the hazards associated with home medicines would fill several thousand pages. Even apparently ‘safe’ substances like vitamins can be dangerous if the recommended dose is exceeded. I have tried to describe some of the commoner hazards associated with the commoner home medicines. To avoid mistakes and side effects always read carefully the manufacturer’s recommendations and warnings.
Warnings obviously vary according to the constituents of particular products but there are four major ones which recur quite frequently. These are:
Do not exceed the stated dose.
Keep out of the reach of children.
Do not take if you are already on medicines prescribed by a doctor.
Do not continue with treatment if symptoms persist.
These warnings are worth adopting as general rules. In my opinion symptoms should be considered persistent if they last for more than five days. (Obviously some symptoms need medical advice well before five days I)
Any medicine that can do good can also do harm and, taken in excess, may prove fatal. Even ordinary iron tablets, taken to protect a patient from developing anaemia or to correct an existing case of anaemia, may kill if taken in too large a quantity by too small a child.
Domestic accidents are an important cause of death nowadays and accidental and deliberate self-poisoning with drugs are two of the major types of domestic accidents. In all it is estimated that no less than one in ten of all medical admissions to hospital are adults who have been poisoned by drugs. An adult in Britain today is more likely to die as a result of poisoning by some chemical substance than he or she is to die in any of the violent ways most of us fear. In the last year for which statistics are available a total of 3977 people died of chemical poisoning while the fatal victims of plane crashes, train crashes, fires, drowning accidents, industrial accidents and homicides added up to 2685.
Many other accidental poisonings involve children and it is vital to remember to keep all medicines locked up and well out of reach. There are some 40,000 poisoning or suspected poisoning cases involving children under fifteen in England and Wales every year, and in some large cities more children die from pill poisoning than from measles, german measles, poliomyelitis, tuberculosis, rheumatic fever, scarlet fever and streptococcal infections put together.
To avoid these dangers it is important not only to keep medicines safely (in childproof bottles) but to throw away all old medicines. Keep only what you’re really likely to use or need. And if you suspect anyone of having taken an overdose, whether by design or accident, seek expert advice at once and show the expert the bottle from which the overdose was most likely to have been taken. Symptoms of accidental poisoning include vomiting, unconsciousness, drowsiness and sweating.
MEDICINES AND ALCOHOL
Inside the body medicines and alcohol are often broken down into their constituent parts in similar ways, using the same organs. They may also have similar side effects. Naturally this means that if you’re taking a medicine and you also drink alcohol the effects of both may be heightened and prolonged. Neither the drug nor the alcohol can be broken down and metabolized at the normal speed. Antihistamines, cold cures and cough medicines are particularly likely to be a problem. So if you’re taking medicines don’t drink. Since home medicines should only be used for a few days at a time the deprivation will not be too dreadful.
DRIVING UNDER THE INFLUENCE
If there are six vehicles waiting in a queue the chances are high that at least one driver will be under the influence of drugs. 1 don’t mean heroin, hashish or cocaine but medicines legally prescribed by a doctor or bought from a pharmacist.
A large variety of different drugs may affect your ability to drive (or operate a fork lift truck, combine harvester or motor bike or navigate a boat or climb a church steeple). Naturally many of the drugs which affect the driver’s ability are prescribed products. Drugs given for anxiety or depression and powerful painkillers can be a problem. But there are also many products which are obtainable without a prescription which can cause difficulties.
Drugs taken for hay fever and allergies in general are particularly likely to cause drowsiness. Every year a manufacturer comes out with a new product that is said not to cause drowsiness. So far most of these claims should be treated with reservation. Travel sickness pills can cause drowsiness too. My wife and I once took some tablets to stop sea sickness when crossing the Channel and though we weren’t sick we didn’t wake up properly until we had been in Paris for two days.
Medicines for coughs and colds need to be taken with care too -they often contain antihistamines.
Always ask the chemist if it is safe to drive while taking a particular product. Or at least read the product label and leaflet. Don’t mix drugs, or drugs and alcohol, and do follow instructions carefully. It’s often a good idea to try out a drug you haven’t used before some time when you are not going to be driving. If you do not drive at the weekend then try it out then. Alternatively use public transport while you experiment with the product.
People can and do get addicted to the strangest things. There was recently a report in the British Medical Journal ofa woman who became addicted to Dettol. More commonly people have become addicted to cough medicines and anti-diarrhoeal medicines.
There are, of course, different types of addiction. Some people become physically addicted on particular drugs, others become psychologically dependent, and yet more simply develop bad habits. Many of those who regularly take laxatives, health salts and so on fall into this third category.
No medicine should ever be taken regularly for more than five days unless it has been prescribed or recommended by a doctor.
MEDICINES THAT GO ‘OFF’
Drugs may deteriorate when stored, particularly if stored in the damp or in direct sunlight, in extremes of heat or of cold. Some drugs when they deteriorate simply become less effective. Others turn into entirely different products – and can, therefore, be exceptionally dangerous.
To minimize the risk of deterioration medicines should be kept in closed containers away from the hazards I’ve outlined above. If your bathroom becomes very damp it may be better to keep your (locked) medicine cabinet in some other room.
And to minimize the risk of taking a deteriorated medicine always throw medicines away when the expiry date suggests that they should be thrown away. In general it is a good idea to keep the home medicine cabinet clear of all products except the ones I list on p 193 as being suitable for keeping in store. Even those products should be replaced every six months or so.
THE PREGNANT WOMAN AND MEDICINES
The horror of the thalidomide story is still in the minds of most people but I never fail to be amazed at the number of pregnant women who take medicines. Many seem to think that home medicines are harmless. They are not. Even ordinary antacids, the ones used for indigestion, may cause problems if taken by pregnant women. As may aspirin tablets.
And it is not only medicines that are swallowed that can cause problems. The substance podophyllin applied to the skin is not normally absorbed, but changes in body physiology during pregnancy can mean that when podophyllin is applied to warts around the anus or vagina of a pregnant woman the unborn baby can be damaged.
It is undoubtedly a fact that many congenital defects are caused by drugs. It is also a fact that as yet we don’t know which drugs cause which problems. The safest course is for pregnant women to avoid taking or using any home medicine. If they need some treatment then they should see a doctor and make sure thathe knows that they are pregnant. The doctor can then at least ensure that the safest available product is used.
Exactly the same applies to women who are breast feeding. Mother’s milk contains the drugs that she is taking and the newly born baby may suffer if the mother uses medicines unwisely.